Takura Tomoyuki, Ebata-Kogure Nozomi, Goto Yoichi, Kohzuki Masahiro, Nagayama Masatoshi, Oikawa Keiko, Koyama Teruyuki, Itoh Haruki
Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan.
Aichi Medical University, Aichi 480-1195, Japan.
Cardiol Res Pract. 2019 Jun 4;2019:1840894. doi: 10.1155/2019/1840894. eCollection 2019.
Medical costs associated with cardiovascular disease are increasing considerably worldwide; therefore, an efficacious, cost-effective therapy which allows the effective use of medical resources is vital. There have been few economic evaluations of cardiac rehabilitation (CR), especially meta-analyses of medical cost versus patient outcome.
The target population in this meta-analysis included convalescent and comprehensive CR patients with coronary artery disease (CAD), the status most commonly observed postmyocardial infarction (MI). Here, we evaluated medical costs, quality-adjusted life year (QALY), cost-effectiveness, mortality, and life year (LY). Regarding cost-effectiveness analysis, we analyzed medical costs per QALY, medical costs per LY, and the incremental cost-utility ratio (ICUR). We then examined the differences in effects for the 2 treatment arms (CR vs. usual care (UC)) using the risk ratio (RR) and standardized mean difference (SMD).
We reviewed 59 studies and identified 5 studies that matched our selection criteria. In total, 122,485 patients were included in the analysis. Meta-analysis results revealed that the CR arm significantly improved QALY (SMD: -1.78; 95% confidence interval (CI): -2.69, -0.87) compared with UC. Although medical costs tended to be higher in the CR arm compared to the UC arm (SMD: 0.02; 95% CI: -0.08, 0.13), cost/QALY was significantly improved in the CR arm compared with the UC arm (SMD: -0.31; 95% CI: -0.53, -0.09). The ICURs for the studies (4 RCTs and 1 model analysis) were as follows: -48,327.6 USD/QALY; -5,193.8 USD/QALY (dominant, CR is cheaper and more effective than UC); and 4,048.0 USD/QALY, 17,209.4 USD/QALY, and 26,888.7 USD/QALY (<50,000 USD/QALY, CR is costlier but more effective than UC), respectively. Therefore, there were 2 dominant and 3 effective results.
While there are some limitations, primarily regarding data sources, our results suggest that CR is potentially cost-effective.
在全球范围内，与心血管疾病相关的医疗费用正在大幅增加；因此，一种有效且具有成本效益、能有效利用医疗资源的治疗方法至关重要。针对心脏康复（CR）的经济评估较少，尤其是关于医疗成本与患者预后的荟萃分析。
本荟萃分析的目标人群包括患有冠状动脉疾病（CAD）的康复期和综合CR患者，这是心肌梗死（MI）后最常见的情况。在此，我们评估了医疗成本、质量调整生命年（QALY）、成本效益、死亡率和生命年（LY）。关于成本效益分析，我们分析了每QALY的医疗成本、每LY的医疗成本以及增量成本效用比（ICUR）。然后，我们使用风险比（RR）和标准化均数差（SMD）研究了两个治疗组（CR与常规护理（UC））在效果上的差异。
我们回顾了59项研究，确定了5项符合我们选择标准的研究。分析共纳入122,485名患者。荟萃分析结果显示，与UC相比，CR组显著改善了QALY（SMD：-1.78；95%置信区间（CI）：-2.69，-0.87）。尽管CR组的医疗成本相较于UC组有升高趋势（SMD：0.02；95%CI：-0.08，0.13），但CR组的成本/QALY相较于UC组有显著改善（SMD：-0.31；95%CI：-0.53，-0.09）。这些研究（4项随机对照试验和1项模型分析）的ICUR如下：-48,327.6美元/QALY；-5,193.8美元/QALY（占优，CR比UC更便宜且更有效）；以及4,048.0美元/QALY、17,209.4美元/QALY和26,888.7美元/QALY（<50,000美元/QALY，CR成本更高但更有效）。因此，有2个占优结果和3个有效结果。
尽管存在一些局限性，主要是关于数据来源，但我们的结果表明CR可能具有成本效益。
